Provider Demographics
NPI:1093124083
Name:CHILD AND ADULT PSYCHOTHERAPY CLINIC, LLC
Entity Type:Organization
Organization Name:CHILD AND ADULT PSYCHOTHERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:414-380-3327
Mailing Address - Street 1:230 W WELLS ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1866
Mailing Address - Country:US
Mailing Address - Phone:414-380-3327
Mailing Address - Fax:414-276-6819
Practice Address - Street 1:230 W WELLS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-1866
Practice Address - Country:US
Practice Address - Phone:414-380-3327
Practice Address - Fax:414-276-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3394123104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871602870Medicaid